Good News For Pain Sufferers

Good news for pain sufferers! Health care professionals have an improved tool to use when assessing your pain and helping you to find ways to manage your pain. A very well-known pain researcher from McGill University in Canada, Dr. Ronald Melzack continues to improve his famous McGill Pain Questionnaire.

Once a very long and involved survey of pain, function, and limitations, Dr. Melzack and his collaborators have found a way to trim the original questionnaire down to just 22 pain descriptors. Patients circle a number from zero (none) to 10 (worst possible) for items such as throbbing pain, itching, numbness, and electric-shock pain. Other choices include hot-burning pain, aching pain, punishing-cruel pain, and cold-freezing pain.

This type of pain descriptor scale with the numbers from zero to 10 is called a numerical rating scale. This particular scale is called the Short-Form McGill Pain Questionnaire (SF-MPQ-2). It is designed to measure all kinds of pain — both neuropathic (nerve pain) and nonneuropathic. Some examples of nonneuropathic pain problems are fibromyalgia, migraine headaches, and low back pain.

Each word descriptor included in the SF-MP-2 has a particular meaning. For example, pain that is amplified by emotions is often described by words such as fearful, sickening, tiring-exhausting, or punishing-cruel. High ratings of these questions would categorize the pain as nonneuropathic. This particular subscale is categorized as affective.

Nerve pain is more often described as shooting, hot-burning, numbness or tingling, or electric-shock. This sensory-based category is the neuropathic subscale. Some of the other descriptors look for a musculoskeletal cause (aching, cramping, heavy, tender) or an underlying cardiovascular cause (throbbing pain). Two other categories that developed out of the preliminary research included continuous (constant) and intermittent (comes and goes) pain experiences.

The process of developing the SF-MPQ-2 involved many steps. Focus groups of patients with chronic pain were gathered together and interviewed. Their ideas and opinions about pain and related-symptoms were incorporated into this revised questionnaire. The survey was given to a group of patients (again, all who had chronic pain) in order to further refine the choice of words and to pretest the questionnaire for ease of use and outcome measures.

When it was all ready to go, this study was done in order to validate the questionnaire (i.e., make sure it is a true measure of neuropathic and nonneuropathic pain). The authors gave the questionnaire over the Internet to 882 people with a wide range of chronic pain syndromes. And they gave the questionnaire to 226 patients with painful peripheral neuropathies caused by diabetes. Neuropathy is another word for nerve pain. Peripheral neuropathy is a condition of nerve damage or irritation of the nerves to the hands and feet. Pain numbness and tingling are the main symptoms of this condition.

The authors make it clear that their intention was NOT to find a way to screen patients for neuropathic versus nonneuropathic pain. They are really just looking for a way to help all chronic pain sufferers better describe their pain. By comparing the answers of patients with neuropathic pain against the answers of patients with nonneuropathic pain, they were able to find new words to describe neuropathic pain. A survey like this also makes it possible to evaluate patients who have mixed (both neuropathic AND nonneuropathic) pain.

They also point out that this tool is meant to be used as a single measure of all types of pain — a questionnaire that is reliable and valid. Such a tool can be used for various types of research on the mechanisms of pain and response to treatment. There’s still much to be done before this new revised short form of the McGill Pain Questionnaire is ready for that type of use.

For example, before using this questionnaire to evaluate before and after results of treatment, a pilot study should be done to validate its use for that purpose. The fact that the people who took the survey did so via the Internet suggests a certain group of individuals who may not reflect the general population. They are more likely to be younger, Caucasian, and well-educated. More study must be done to confirm these results with a broad base of individuals with chronic pain who are from all walks of life and circumstances. And there’s no way to know if the person in pain was the one to fill out the form or if perhaps, a partner or family member did so for them.

In summary, the Short-Form McGill Pain Questionnaire is an all around good measure of neuropathic and nonneuropathic pain intensity and quality. The questionnaire is an expanded and revised version of a previous short-form McGill Pain Questionnaire — that’s why they gave it the number two after the name: SF-MPQ-2. Even though more study will be done on this tool, for right now, it’s ready to be used in clinical research and practice.